Amygdala and Insula Connectivity Changes Following Psychotherapy for Posttraumatic Stress Disorder: A Randomized Clinical Trial.
Amygdala and Insula Connectivity Changes Following Psychotherapy for Posttraumatic Stress Disorder: A Randomized Clinical Trial.
复制标题
DOI：
10.1016/j.biopsych.2020.11.021
复制
发表时间：
2021-05-01
影响因子：
10.6
通讯作者：
Etkin A
中科院分区：
文献类型：
--
作者：
Fonzo GA;Goodkind MS;Oathes DJ;Zaiko YV;Harvey M;Peng KK;Weiss ME;Thompson AL;Zack SE;Lindley SE;Arnow BA;Jo B;Rothbaum BO;Etkin A
基于暴露的心理治疗是创伤后应激障碍（PTSD）的一线治疗方法，但其机制知之甚少。功能性脑连接是用于识别治疗机制和治疗反应的生物特征的有前途的度量。为此，我们评估了杏仁核和杏仁核治疗相关的连接变化及其与PTSD症状改善的关系。患有原发性PTSD诊断的个体（N=66）参加了一项长期暴露治疗（N=36）与治疗等待名单（N=30）的随机临床试验。在随机化前和停止治疗/等待名单后1个月完成无任务功能磁共振成像（fMRI）。获得全脑血氧水平依赖性（BOLD）反应。内在的连通性进行了评估，通过分区，在杏仁核和海马，边缘结构的关键障碍的病理生理学。动态因果模型（DCM）评估的证据，有效的连接变化，在选择节点通知内在的连接结果。杏仁核和杏仁核显示了广泛的模式，主要是亚区域一致的内在连接变化，包括杏仁核和杏仁核之间的连接增加;增加这两个区域与腹侧前额叶皮层，额极，感觉皮层的连接;和减少这两个区域与执行控制网络的左额顶叶节点的连接。杏仁核-额叶连接性和岛叶-顶叶连接性的较大降低与PTSD症状的较大减轻相关。DCM证据表明，治疗降低了左杏仁核的左额叶抑制，并且较大的降低与较大的症状减轻相关。PTSD心理治疗自适应地减弱额顶叶和边缘脑回路之间的功能相互作用，这可能反映了潜在的机制或恢复的生物特征。创伤后应激障碍（PTSD）心理治疗的脑成像 NCT01507948 https://clinicaltrials.gov/ct2/show/NCT01507948
Exposure-based psychotherapy is a first-line treatment for posttraumatic stress disorder (PTSD), but its mechanisms are poorly understood. Functional brain connectivity is a promising metric for identifying treatment mechanisms and biosignatures of therapeutic response. To this end, we assessed amygdala and insula treatment-related connectivity changes and their relationship to PTSD symptom improvements. Individuals (N=66) with a primary PTSD diagnosis participated in a randomized clinical trial of prolonged exposure therapy (N=36) vs. treatment waiting list (N=30). Task-free functional magnetic resonance imaging (fMRI) was completed prior to randomization and 1 month following cessation of treatment/waiting list. Whole-brain blood oxygenation level-dependent (BOLD) responses were acquired. Intrinsic connectivity was assessed, by subregion, in the amygdala and insula, limbic structures key to the disorder pathophysiology. Dynamic causal modeling (DCM) assessed evidence for effective connectivity changes in select nodes informed by intrinsic connectivity findings. The amygdala and insula displayed widespread patterns of primarily subregion-uniform intrinsic connectivity change, including increased connectivity between amygdala and insula; increased connectivity of both regions with the ventral prefrontal cortex, frontopolar, and sensory cortices; and decreased connectivity of both regions with left fronto-parietal nodes of the executive control network. Larger decreases in amygdala-frontal connectivity and insula-parietal connectivity were associated with larger PTSD symptom reductions. DCM evidence suggested treatment decreased left frontal inhibition of the left amygdala, and larger decreases were associated with larger symptom reductions. PTSD psychotherapy adaptively attenuates functional interactions between frontoparietal and limbic brain circuitry at rest, which may reflect a potential mechanism or bio-signature of recovery. Brain Imaging of Psychotherapy for Posttraumatic Stress Disorder (PTSD) NCT01507948 https://clinicaltrials.gov/ct2/show/NCT01507948
登录
查看更多内容
DOI：
10.1038/s41583-018-0039-7
发表时间：
2018-09
期刊：
Nature reviews. Neuroscience
影响因子：
--
作者：
Fenster RJ;Lebois LAM;Ressler KJ;Suh J
通讯作者：
Suh J
影响因子：
10.6
作者：
Baur, Volker;Haenggi, Juergen;Jaencke, Lutz
通讯作者：
Jaencke, Lutz
影响因子：
5.7
作者：
Friston, Karl J.;Penny, Will
通讯作者：
Penny, Will
影响因子：
5.7
作者：
Frassle, Stefan;Lomakina, Ekaterina I.;Stephan, Klaas E.
通讯作者：
Stephan, Klaas E.
影响因子：
25.4
作者：
Foa, Edna B.;Gillihan, Seth J.;Bryant, Richard A.
通讯作者：
Bryant, Richard A.